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Home
About
COVID-19 Information
Team
Mission and Vision
Programs
Day at the Beach
Wounded Warrior
Adaptive Surfing Clinic
Adaptive Swim Clinic
Canoe Day
Hawaii Adaptive Surf Team
Media
Sponsors
Get Involved
Donate
Volunteer
Participate
Forms
Participant Form and Waiver
Volunteer Form and Waiver
Testimonials
COVID-19 Volunteer Opportunities
Other Volunteer Opportunities
Events
Events Calendar
Virtual Clinic Registration
Online Adaptive Surfing Contest Pictures
News
Contact
Donate
Shop
Observation Questionnaire Surfing
Observation Questionnaire Surfing
First Volunteer
*
Second Volunteer
Third Volunteer
AccesSurfer Name
*
Date of Most Recent Activity (Referred to as: "Today" in fields below)
*
How long has the AccesSurfer been surfing with AccesSurf? month/year (if known)
How many times have you worked with the AccesSurfer? (estimate)
Which water activity did you help the AccesSurfer with?
Surfing
Swimming
Paddling
Other
Which water activity did you help the AccesSurfer with?
1. Where did you and the AccesSurfer surf?
The first time you surfed with the AccesSurfer:
White Plains Beach AccesSurf Day at the Beach
Other
Other
Today:
White Plains Beach AccesSurf Day at the Beach
Other
Other
2. How was the access to the water?
The first time you surfed with the AccesSurfer:
Beginner
Intermediate
Advanced
Today:
Beginner
Intermediate
Advanced
3. How were the environmental conditions? (Water, wind, current, waves, crowds):
The first time you surfed with the AccesSurfer:
Beginner
Intermediate
Advanced
Today:
Beginner
Intermediate
Advanced
4. What is the surfing style of the AccesSurfer?
When they first joined AccesSurf:
Prone (on their stomach)
Sitting
Kneeling
Standing
Other
Other
Today:
Prone (on their stomach)
Sitting
Kneeling
Standing
Other
Other
5. How much assistance in the water did the AccesSurfer need?
When they first joined AccesSurf:
Independent (surfing on their own with minimal assistance in the water)
Assisted (surfing on their own with instructor close by for assistance)
Dependent (Surfing tandem with an instructor)
Today:
Independent (surfing on their own with minimal assistance in the water)
Assisted (surfing on their own with instructor close by for assistance)
Dependent (Surfing tandem with an instructor)
6. How does the AccesSurfer access the water?
When they first joined AccesSurf:
Walking unassisted
Walking assisted
Crawling
Beach Wheel-Chair
Carried (fireman's, princess, backpack, etc.)
Other
Other
Today:
Walking unassisted
Walking assisted
Crawling
Beach Wheel-Chair
Carried (fireman's, princess, backpack, etc.)
Other
Other
Comfort Level Scale
Very Uncomfortable
Uncomfortable
Neutral (OK, Alright)
Comfortable
Very Comfortable
1
2
3
4
5
7. How comfortable is the AccesSurfer talking to new people at AccesSurf?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
8. How comfortable is the AccesSurfer entering the water?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
9. How comfortable is the AccesSurfer in the water (on a surfboard)?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
10. How comfortable is the AccesSurfer when falling or wiping out?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
Level of Communication and Dependency
Totally Dependent
Max Assist
Min Assist
Verbal Assist
Self Direct
Totally Independent
1
2
3
4
5
6
11. How does the AccesSurfer prepare for surfing? (sun protection, hydration, equipment, meds, leash, wax, leg straps, fins, etc.)
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
12. How does the AccesSurfer choose the path to enter the water?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
13. How does the AccesSurfer paddle out to surf?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
14. How does the AccesSurfer select surfable waves?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
15. How does the AccesSurfer catch waves?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
16. How does the AccesSurfer ride waves?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
17. How does the AccesSurfer recover after wiping out?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
18. How does the AccesSurfer manage underwater situations?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
19. How does the AccesSurfer direct needs and wants to surf? (e.g. selection of waves, white water, lost equipment, etc.)
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
20. How long can the AccesSurfer endure a surf session? (with breaks in the water)
When they first joined AccesSurf:
less than 20 minutes
20 minutes
30 minutes
40 minutes
50 minutes
1 hour
Today:
less than 20 minutes
20 minutes
30 minutes
40 minutes
50 minutes
1 hour
Community Integration Scale
Always Disagree
Sometimes Disagree
Neutral
Sometimes Agree
Always Agree
1
2
3
4
5
21. The AccesSurfer knows a number of people in AccesSurf to initiate a greeting and a receive a greeting in return.
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
22. The AccesSurfer has developed a support system at AccesSurf events.
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
23. The AccesSurfer is able to access new locations in the community.
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
24. Does the AccesSurfer participate in water activities outside of AccesSurf events and how often?
When they first joined AccesSurf:
None
Only AccesSurf Events
Once a month
Twice a month
Once a week
More than once a week
Today:
None
Only AccesSurf Events
Once a month
Twice a month
Once a week
More than once a week
Do you recall any other changes/improvements you've observed since working with this AccesSurfer?
Comments:
Thank you very much!
Submit
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